Hypertension Bệnh lý nền

Cập nhật: 18 June 2024

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Introduction 

Content:

Introduction 

Hypertension is the medical term for high blood pressure. 

Epidemiology 

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

The overall crude prevalence of hypertension in China based on the 2012-2015 national survey was 27.9% among those ≥18 years old, directly correlated with increasing age. In Hong Kong, hypertension is one of the most common diseases with prevalence rates ranging between 27.7-29.5% among those ≥15 years old. In Korea, approximately 30% of Koreans aged ≥30 years old have hypertension.  

Over one-third of the population of Indonesia is diagnosed with hypertension. The prevalence rate was 34.5% based on the May Measurement Month in 2017 and 34.1% based on previous surveys in 2018. The National Health and Morbidity Survey in Malaysia reported that there was an increasing trend in the overall prevalence of hypertension which were 34.6% in 2006, 33.6% in 2011, and 35.3% in 2015 among those ≥18 years old.  

The Philippine Heart Association’s PRESYON-4 reported that the point prevalence in the Philippines increased to 34% in 2020 from 28% in 2013. Nevertheless, the National Nutrition Survey reported that the prevalence decreased from 23.9% in 2013 to 19.2% in 2018 among those 20-59 years old and 41.2% in 2015 to 35% among the elderly in 2018. The WHO reported that the prevalence of hypertension in Myanmar was 30.1% among those 25-64 years old in 2014, which was similar to the prevalence rate reported by a cross-sectional study that utilized data from a survey in 2009.  

The Singapore National Health Survey (NHS) in 2010 reported that the crude prevalence of hypertension in Singapore was decreasing from 27.3% in 1998, 24.9% in 2004, and 23.5% in 2010 among those 30-69 years old. Among 18-69 years old, the prevalence was 18.9% in 2010. In Thailand, however, the overall prevalence of hypertension increased from 21% in 2003 to 25% in 2014. In Vietnam, the prevalence was 25.1% based on a national survey from 2001-2008 among those aged ≥25 years old. Based on the May Measurement Month, the prevalence of hypertension was increasing with prevalence rates of 28.7% in 2017, 30.3% in 2018, and 33.8% in 2019.  

In India, the prevalence rate of hypertension was estimated to be between 20-30%, without considering the updated definition by the ACC/AHA. However, a study in 2017 concluded that applying the updated definition caused a significant increase in the prevalence rate to 40.6%.  

Hypertension remains to be one of the top causes of morbidity and mortality in these countries and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-HK

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

The overall crude prevalence of hypertension in China based on the 2012-2015 national survey was 27.9% among those ≥18 years old, directly correlated with increasing age. In Hong Kong, hypertension is one of the most common diseases with prevalence rates ranging between 27.7-29.5% among those ≥15 years old.

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-ID

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

Over one-third of the population of Indonesia is diagnosed with hypertension. The prevalence rate was 34.5% based on the May Measurement Month in 2017 and 34.1% based on previous surveys in 2018.

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-MY

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

The National Health and Morbidity Survey in Malaysia reported that there was an increasing trend in the overall prevalence of hypertension which were 34.6% in 2006, 33.6% in 2011, and 35.3% in 2015 among those ≥18 years old.  

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-PH

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.

The Philippine Heart Association’s PRESYON-4 reported that the point prevalence in the Philippines increased to 34% in 2020 from 28% in 2013. Nevertheless, the National Nutrition Survey reported that the prevalence decreased from 23.9% in 2013 to 19.2% in 2018 among those 20-59 years old and 41.2% in 2015 to 35% among the elderly in 2018.

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-SG

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

The Singapore National Health Survey (NHS) in 2010 reported that the crude prevalence of hypertension in Singapore was decreasing from 27.3% in 1998, 24.9% in 2004, and 23.5% in 2010 among those 30-69 years old. Among 18-69 years old, the prevalence was 18.9% in 2010.

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-TH

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

In Thailand, the overall prevalence of hypertension increased from 21% in 2003 to 25% in 2014.

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Epidemiology-VN

The World Health Organization (WHO) estimated hypertension to occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are living in low- and middle-income countries. About 46% of adults with hypertension are not aware that they have hypertension while about 42% of adults with hypertension are diagnosed and managed.  

The global prevalence of hypertension using the 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.  

In Vietnam, the prevalence was 25.1% based on a national survey from 2001-2008 among those aged ≥25 years old. Based on the May Measurement Month, the prevalence of hypertension was increasing with prevalence rates of 28.7% in 2017, 30.3% in 2018, and 33.8% in 2019.

Hypertension remains to be one of the top causes of morbidity and mortality in Asia and although the level of awareness, treatment, and control are steadily increasing, they remain to be low.

Pathophysiology 

Hypertension may be due to multiple factors including neural and chemical disorders, alterations of vascular caliber and elasticity, cardiovascular reactivity, and blood volume and viscosity.

Blood pressure maintenance is complex and involves several physiological mechanisms including arterial baroreceptors, the renin-angiotensin-aldosterone system, atrial natriuretic peptide, endothelins, and mineralocorticoid and glucocorticoid steroids, which together manage the degree of vasoconstriction or vasodilation within the systemic circulation, and the retention of water and sodium to maintain adequate circulating blood volume and dysfunction in any of these processes can lead to hypertension development.

Sympathetic neural activation modulates hypertension by enhancing vasoconstriction and vascular remodeling, producing renal renin via beta 1 adrenergic receptors in the juxtaglomerular apparatus and increasing renal sodium resorption and inflammation.   

Classification 

Classification of Blood Pressure

The classification must be based on the average of ≥2 properly measured, seated blood pressure readings on each of ≥2 office visits. Various consensus guidelines are available as standard references for the definition of hypertension.1
BP Classification Based on 
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA*
SBP (mmHg)     DBP (mmHg)
Normal
    <120   and   <80
Elevated
    120-129   and   <80
Hypertension Stage 1
    130-139   or   80-89
Hypertension Stage 2
    ≥140   or   ≥90
 
BP Classification Based on 2023 ESH** SBP (mmHg)      DBP (mmHg)
Optimal
    <120   and   <80
Normal
    120-129   and   80-84
High Normal
    130-139   and/or   85-89
Grade 1 hypertension
    140-159   and/or   90-99
Grade 2 hypertension
    160-179   and/or   100-109
Grade 3 hypertension
    ≥180   and/or   ≥110
Isolated systolic hypertension (ISH)2
    ≥140   and   <90
1Recommendations may vary between countries. Please refer to available guidelines from local health authorities.
*Reference: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. This guideline updates prior JNC reports.
**Reference: 2023 European Society of Hypertension (ESH) Guidelines for the management of arterial hypertension. 
2Graded 1, 2, or 3 according to the systolic blood pressure values in the indicated ranges.

Stages of Hypertension

 

  • Stage 1: Uncomplicated hypertension (without hypertension-mediated organ damage [HMOD], diabetes, established cardiovascular disease [CVD] or chronic kidney disease [CKD] stage ≥3)
  • Stage 2: Presence of HMOD, diabetes, or CKD stage 3
  • Stage 3: Presence of established CVD or CKD stage 4 or 5